Rheumatoid arthritis (RA) is an autoimmune disorder that causes chronic inflammation and pain in the joints. But RA can also affect other organs in the body, such as the heart and lungs.
An autoimmune disorder, rheumatoid arthritis (RA) presents as chronic pain and inflammation in the joints. Joint damage usually occurs on both sides of the body, meaning that if a joint in an arm or leg is affected, the same joint in the other arm or leg will likely be affected as well.
Other organs in the body can be affected by RA, as well, particularly the heart and lungs. While cardiovascular disease is the number one contributor to early death in patients with RA, lung disease ranks second. Over time, RA can cause damage to lung tissue, resulting in a condition known as pulmonary fibrosis.
In pulmonary fibrosis, thickening and scarring of lung tissue occurs. This makes it more difficult for oxygen to get absorbed into the bloodstream. As a result, the condition causes severe breathing problems, including shortness of breath and persistent coughing. Other symptoms include weight loss that is unintentional, fatigue, and a change in the tips of the fingers or toes -- they become wider and rounder.
It is still unknown what exactly causes pulmonary fibrosis, but it is believed that the inflammation associated with RA can heighten its risk. Research shows that high levels of RA antibodies are associated with the development of interstitial lung disease. In turn, this serious, life-threatening condition can develop into pulmonary fibrosis. “Recent work has indicated that ILD may be a feature of early RA, that the prevalence increases with advancing age, and the diagnosis of ILD in RA carries a poor prognosis, oftentimes similar to idiopathic pulmonary fibrosis” wrote David O’Dwyer of University of Dublin and fellow colleagues.
While medical experts do not fully understand the link between RA and pulmonary fibrosis, evidence shows that over 40% of individuals with RA also have pulmonary fibrosis. “We’re learning that there aren’t hard and fast rules about this disease. The textbooks say that patients are supposed to have really bad joint disease, then you get lung disease. In real life, some people start with lung disease years before they develop arthritis. We need to break down our simplistic versions of these diseases” said Dr. Aryeh Fischer, a rheumatologist.
Pulmonary fibrosis development is is heightened in individuals who:
- Have pulmonary fibrosis in their family history
- Have a personal history of gastroesophageal reflux disease;
- Are frequent smokers
- Have regular contact with environmental pollution
- Use anti-inflammatory medication on a regular basis;
A pulmonary fibrosis diagnosis begins with the physician inquiring about an individual’s symptoms, a review their medical and family history, and a thorough physical exam. Specific tests can be performed, including:
- Pulmonary function test – This test shows the amount of air that an individual can hold in their lungs and the way in which the air flows in and out of the lungs;
- Pulse oximetry – This test measures the amount of oxygen in an individual’s blood;
- Arterial blood gas test – This test uses a blood sample to measure an individual’s oxygen and carbon dioxide levels;
- Imaging tests – A chest X-ray and CT scan can be used to reveal scarred lung tissue, while an echocardiogram can be used to identify abnormal pressures in the heart caused by pulmonary fibrosis;
- Lung tissue biopsy – This procedure involves removing a small amount of lung tissue through a bronchoscopy or a surgical biopsy and examining it under a microscope to determine if lung disease is present;
An “extra-articular” site of attack
Most often, pulmonary fibrosis and related lung problems develop in individuals who have lived with RA for several years. However, a study published in the journal European Respiratory Review reported that 10-20% of individuals experienced symptoms of lung problems before they developed typical RA symptoms.
In any case, complications arising from pulmonary fibrosis associated with RA can become life-threatening if not treated immediately. They include pulmonary hypertension, a collapsed lung, pleural effusion, respiratory failure, and interstitial pneumonia. According to the National Rheumatoid Arthritis Society, individuals living with RA should see their doctor if they experience any of these complications or lung problems for more than 4 weeks. They should also see their doctor if they experience sudden, but severe breathing difficulties while performing daily tasks.
Seeing as how a cure for both RA and pulmonary fibrosis remains to be found, the main objective is to manage symptoms and reduce progression of the diseases. The doctor will assess the extent of the problem and recommend a treatment plan based on his or her analysis. The medications and treatments that are commonly used to control pulmonary fibrosis associated with RA include anti-inflammatory medications, corticosteroids and immunosuppressants, pulmonary rehabilitation therapy, and oxygen therapy.
Maximizing the benefits
Pulmonary fibrosis associated with RA progresses differently from individual to individual. Some experience worsening of symptoms within months, while for others, the disease may take a couple of years to advance. If an individual has RA and experiences lung problems, he or she should talk to a pulmonologist and a rheumatologist on how to best monitor disease progression and to decide the best course of treatment. This is often done on an individualized basis because the nature and frequency of symptoms, disease course, and response to treatment is different for each patient.
In addition to available treatment options, keeping the lungs as healthy as possible through lifestyle changes (such as quitting smoking and exercising whenever possible) is of the utmost importance.